Clinicopathologic Analysis Of ASC-H And Exploration For The Relation Between HPV Examination And The Pathological Outcome Of ASC-H

ObjectiveIn this study,we collected the histopathological finding of patients with atypical squamous cells and without exclusion of high-grade squamous intraepithelial lesions(ASC-H)and their laboratory results of human papillomavirus(HPV).Then we explored the correlation between the above two and provided the new way for the classification management of ASC-H with negative results by colposcopy.MethodsA retrospective analysis was performed on 517 patients diagnosed with ASC-H by thinprep cytologic test from June 2011 to September 2017.Sixty-five patients of them with the final pathological diagnosis of mucosal chronic inflammation,LSIL,HSIL and cervical cancer were detected by real-time PCR for the viral loads of HPV.And we preliminary found out the relativity of the HPV test results and the pathological outcome of ASC-H.Results(1)The final histopathological diagnosis consist of 120 casesnormal or inflammatory in,56casese LSIL,306 cases HSIL and 35 cases cervical cancer.(2)The analysis of cervical lesions in different age groups showed that the diagnosis rate of HSIL+was 52.8%in the<30 group and 67.4%in the>30 group(P<0.05).(3)72.7%of colposcopy biopsy was consistent with postoperative histopathological estimates,Kappa value was 0.299(P<0.001).(4)HPV test was performed in ASC-H patients with the sensitivity of 100%and the negative predictive value of 100%.(5)Among all ASC-H tissue samples and the≤LSIL group,the top three detection rate were from HPV16(39.6%),HPV 52(18.9%)and HPV 58(17.0%).In the group≤LSIL,the top three were HPV16(26.3%),HPV52(26.3%)and HPV58(21.1%)respectively.And the most common subtype was HPV16(47.1%)in the group≥HSIL,significantly higher than other subtypes(P<0.05).(6)HPV viral load in the≤LSIL group was lower than the≥HSIL group(P<0.001).When the cut-off value of HPV DNA viral load was 1.09×10~4copy number/10~4 cells,the predictive sensitivity of≥HSIL was 67.6%,the specificity was 83.3%,and the area under the curve was0.832(95%CI0.721～0.942).(7)The mean viral load of HPV16,HPV52 and HPV58 in the≥HSIL group was greater than that in the≤LSIL group(P<0.05).(8)The effect of mixed infection and single infection on lesion degree was not statistically significant.ConclusionsASC-H indicates a high risk of HSIL,but people<30 years old are more likely to be LSIL.The negative result for HPV has a high predictive value of negative for ASC-H;The positive result in ASC-H patients can be further shred according to viral load。HPV16,52,58 subtypes were closely related to cervical lesions.The HPV viral load increased with the aggravating of the cervical lesions degree.In summary,we inferred that it’s predictive of real-time HPV examination for the pathological outcome of ASC-H and it could be an option for the distribution management for ASC-H with negative results by colposcopy.